Resurrection Health Care: Hospital Quality 2007

Ensuring Quality Healthcare at Resurrection Hospitals

Resurrection Health Care is the second largest hospital chain in the Chicago metropolitan area. This report examines available measures of hospital quality to see how Resurrection Health Care compares to other hospitals in our region.

The information included in this report is provided to consumers as a starting point for making informed healthcare choices. It is based on data developed by government, healthcare purchasers and independent oversight groups. By choosing hospitals that invest in patient safety measures and by voicing concerns over quality problems to hospital management, educated consumers can play a significant role in improving quality care for themselves and for all patients.

WHY DOES QUALITY HOSPITAL CARE MATTER?

Unlike healthcare workers, most of us don't think about hospital quality on a daily basis. But chances are great that at some point we or loved one will be hospitalized—whether for a joyful event such as the birth of a child or for treatment of a serious injury or illness.

Study after study has shown that the choices hospitals make about where to allocate resources have a direct impact on patients' well-being.

In 1999 the Institute of Medicine released an alarming report, To Err is Human: Building a Safer Healthcare System. The study estimated that between 44,000 and 98,000 people die unnecessarily each year from hospital medical errorsⁱ.
A 2002 study published in the Journal of the American Medical Association found a clear link between nurse staffing levels and patient outcomes. Researchers found that for each patient above four assigned to a registered nurse there was a seven percent increase in both patient mortality and deaths following complications. This means an estimated 20,000 preventable deaths a year nationwide due to inadequate staffing levelsⁱⁱ.
Infections contracted in hospitals are the fourth largest killer in the United States, causing as many deaths as AIDS, breast cancer and auto accidents combined. One out of every twenty hospital patients gets an infection. That's two million Americans a year, and an estimated 103,000 of them die as a resultⁱⁱⁱ.

Frontline Healthcare Professionals Sound the Alarm

Nurses and other patient care workers at Resurrection Health Care hospitals report dramatic changes as the corporation has grown from a single community hospital to a multi-hospital system with revenues topping a billion dollars a year. As the system has grown, executive pay and revenues have increased sharply, but the percentage of revenues spent on bedside care has actually declined.

Reports indicate that short staffing, as well as inadequate equipment and supplies, are linked to conditions that can place patients at risk. Employees have made repeated efforts to bring these concerns to management's attention with little success. Publicly available evidence on Resurrection's performance confirms that concerns over quality are well-founded and well documented.

RESURRECTION HEALTH CARE HOSPITALS

Resurrection Medical Center
Our Lady of the Resurrection Hospital
St. Francis Hospital of Evanston
Westlake Hospital
St. Mary of Nazareth Hospital (Also referred to as Saints Mary and Elizabeth Medical Center—Division Campus)
St. Elizabeth Hospital (Also referred to as Saints Mary and Elizabeth Medical Center —Claremont Campus)
Holy Family Medical Center (converted to a long-term acute care hospital in 2005)
St. Joseph Hospital
West Suburban Medical Center

Resurrection Health Care Hospitals Cited Repeatedly by Public Health Authorities

The Illinois Department of Public Health and the federal government's Centers for Medicare and Medicaid Services work together to investigate life-threatening patient safety problems and ensure that hospitals meet standards set to protect all patients, particularly vulnerable elderly patients on Medicare.

Over the past three years the Illinois Department of Public Health found 395 deficiencies at Resurrection Health Care hospitals. During the same period, seven of the system's nine hospitals were deemed to be out of compliance with the minimum standards for participation in the Medicare program and placed on monitoring by the state.

In each case the Medicare program informed the hospital that: “We have determined that the defi ciencies identified are significant and limit your hospital's capacity to render adequate care and ensure the health and safety of your patientsvi.” The number of deficiencies cited has increased each year over the past three years, jumping from eight in 2004 to 206 in 2006.

“We have determined that the deficiencies identified are significant and limit your hospital's capacity to render adequate care and ensure the health and safety of your patients.”

In 2006, six of the system's nine hospitals were investigated by public health regulators and deficiencies were cited at five hospitals. Deficiencies at three facilities were so severe they resulted in regulators placing the hospitals on state monitoring.

The problems cited were significant. They involved short-staffing, inadequate infection control, unsanitary conditions, failure to maintain safe levels of supplies and failure to enforce medication protocols. Some problems involved patient injuries and deaths, while other revealed conditions that could place patients at serious risk.

From 2006 public health inspection reports re Resurrection Health Care hospitals:

“Hospital failed to ensure that expired drugs and biologicals were not available for patient use.”
“Hospital failed to ensure that a neuropenic [immune-compromised] was provided with a sanitary room.” patient room.
“Hospital failed to ensure... that appropriate safety measures were implemented to prevent patient falls.”
“Facility failed to provide and maintain a safe environment for patients and staff.”
“Hospital failed to ensure that surgical staff adhered to policies to prevent cross contamination.”
“Hospital failed to ensure that supplies were maintained at an acceptable level of safety and quality.”
“Hospital failed to ensure that only a physician orders and administers conscious sedation agents.”

The investigations shine a light on just a few of the dire outcomes that patient care workers see with alarming frequency—many of which workers say are linked to shortstaffing and the lack of adequate resources:

Resurrection Medical Center—A pregnant emergency room patient suffering from abdominal pain was classified as “emergent,” defined as an “acute/life-threatening emergency.” She entered the ER at 7:55 pm, and waited until 1:30 am to receive the ultrasound ordered. At 3:30 am she was transferred to the obstetrics department Fifteen minutes later, complaining of pain and nausea, she went into cardiac arrest and died. The investigation of emergency room records found evidence that the hospital had failed to follow its own guidelines for regularly assessing emergency room patients in this case and in other similar cases.
Resurrection Medical Center—A patient was placed in restraints for two days straight. Public health investigators found no record of a physician order on the second day.
West Suburban Medical Center—A patient found to be at high risk of skin breakdown developed a pressure ulcer and a gangrenous foot, which resulted in a leg amputation. Investigators found no record that the patient was repositioned and reassessed at regular intervals on 23 of the 44 days he was hospitalized.
Resurrection Medical Center—A patient who came to the emergency room complaining of severe abdominal pain (he rated his pain 10 on a scale of 1 to10) was classified as “urgent” instead of the higher-level “emergent” and sent to wait in the waiting area. After waiting for over an hour and forty-five minutes the patient went into cardiac arrest and died before he reached an ER room.
Resurrection Medical Center—A rehabilitation patient classified as high-risk for falls was seriously injured in a fall in the bathroom. Investigators found that management failed to adhere to a physician's orders to provide a sitter on the day of the fall.
St. Francis of Evanston—An immune compromised patient was placed in a room with a leak dripping onto his bed from the ceiling. Hospital staff told investigators they had been complaining about the leak for over a year without result.
Resurrection Medical Center—A patient with injuries related to a fall was exposed to a roommate later diagnosed with tuberculosis. Investigators found no evidence that the hospital ensured proper follow up with either the patient who was exposed, or the nursing home where he was later transferred.

How Do Resurrection Hospitals Compare on Practices and Procedures Critical to Patient Safety and Wellbeing?

In an effort to inform consumers and reward hospitals that perform well, the Centers for Medicare and Medicaid Services (CMS) and the US Department of Health and Human Services recently began requiring hospitals to report data on how frequently hospitals adhere to the practices and procedures identified as essential to patient wellbeing. This effort, known as CMS Hospital Compare, collects information on 20 “measures.”

Each measure is a treatment known to get the best results for most adult patients in four categories: heart attack, heart failure, pneumonia, and surgery. For example, providing an aspirin to patients with heart attack symptoms can help keep blood clots from forming and dissolve blood clots that can cause heart attacks.

The data indicate that Resurrection hospitals as a group failed to provide the optimum treatment in nearly a quarter of the patient encounters sampled (24%)vii. As a system Resurrection hospitals were below top performing hospitals (those that scored in the top 10% nationally) on 91% of measures, and below the state average on nearly half (48%) of measures where data was reported^viii.

What Does Illinois' Largest Healthcare Insurer Report About Resurrection?

Like many health insurance providers, BlueCross BlueShield of Illinois has committed to providing healthcare consumers with information to help them make informed choices.

The Blue Star Hospital Report published by BlueCross BlueShield of Illinois divides hospitals into five peer groups based on size, case mix index, scope of teaching programs and complexity of services offered. Hospitals are given a “blue star” based on how well their performance compares to other hospitals in the same peer group. The Blue Star Hospital Reports use data from three sources: Leapfrog Group, Hospital Quality Alliance and the Agency for Healthcare Research and Quality (AHRQ) (see box on page 7).

Only two RHC hospitals were recognized by Leapfrog for either full implementation or good progress in at least one of the three categories examined, “computerized physician order entry”, “intensive care unit staffing” or “safe practices.”^ix

Progress on Leapfrog Recommedations Chart

Only one RHC hospital earned a star for the Hospital Quality Alliance measuresx. A star in this category indicates that the hospital met or exceeded state or national thresholds in treating three serious medical conditions and preventing surgical infection.

Agency for Healthcare Research and Quality (AHRQ)

The Agency for Healthcare Research and Quality, an arm of the U.S. Department of Health and Human Services, supports research to improve healthcare quality and patient safety. Its in-patient quality indicators use hospital administrative data to examine quality of care inside hospitals. These measures are designed to examine procedures for which mortality has been shown to vary across institutions and for which there is evidence that high mortality may be associated with poorer quality of care.

Leapfrog Group

The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America's health industry that big leaps in healthcare safety, quality and customer value will be recognized and rewarded. Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to healthcare information as well as rewards for hospitals that have a proven record of high quality care.

Hospital Quality Alliance

The Hospital Quality Alliance: Improving Care Through Information (HQA) is a public-private collaboration to improve the quality of care provided by the nation's hospitals by measuring and publicly reporting on that care. This collaboration includes the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association, the Federation of American Hospitals, and the Association of American Medical Colleges.

Only three RHC hospitals earned a star for meeting AHRQ quality indicator benchmarks^xi. A star indicates the hospital was in the best quartile within its peer group for mortality rates for six specific medical conditions. Only three RHC hospitals earned a star for meeting AHRQ patient safety indicator benchmarks. A star indicates the hospital's complication rates were better than most other hospitals in its peer group.

Resurrection Hospitals Switch Accreditation Bodies, Weakening Quality Oversight.

All nine Resurrection Hospitals recently switched from the widely recognized leader in the field, the Joint Commission on the Accreditation of Health Care Organizations (JCAHO), to the less stringent and transparent American Osteopathic Association’s Health Facilities Accreditation Program (HFAP)^xii. Other than Resurrection hospitals, only 11 of the state’s 228 hospitals are accredited through the HFAP program.

Resurrection’s switch comes at a time when JCAHO has taken significant steps to more effectively guard against medical errors, including the introduction of new standards and survey protocols aimed at strengthening quality oversight. JCAHO has begun conducting unannounced survey visits, during which hospital managers are required to demonstrate that their facility can control infections, manage medications and maintain adequate staffing for the volume and clinical condition of patients. In contrast, under the HFAP program, the Resurrection system is no longer subject to unannounced survey visits and records from Resurrection’s accreditation inspections are no longer publicly available^xiii.

How do Resurrection's Prices Compare to Other Area Hospitals?

Resurrection's performance on quality is especially disturbing in light of charges far out of line with industry averages. Each year hospitals are required to report their “markup” (the difference between list price and the actual cost of care provided) to the Medicare program. In 2003 and 2004 Resurrection had the highest price markup of any Illinois health system—charges that were 315% of its costs in 2003 and 336% in 2004^xiv.

Among the ten hospitals with the highest markup in Illinois three were Resurrection owned. Our Lady of the Resurrection had the highest markup in the state in 2003 and the second highest markup in 2004^xv.

RX for Quality: What You Can Do to Ensure Better Care at Resurrection Hospitals

Informed consumers can play an important role in promoting higher quality hospital care, reducing preventable deaths and infections and ensuring that Resurrection Health Care's priorities are in line with its historic mission: Get More Information: For more information and links to the primary sources cited in this publication, more information about legislative efforts to ensure safe staffing levels and personal accounts from Resurrection Health Care workers, go to our website at www. reformresurrection.org.

Ask Questions: If you are considering seeking treatment for planned medical care at a Resurrection hospital (such as the birth of a child or outpatient surgical procedure), call the hospital or request a visit and let hospital administrators know you care about quality. Ask for specifics about staffing levels, mortality and complication rates and performance on standard indicators such as CMS Hospital Compare measures.

Tell Us About Your Experience: The numbers tell only part of the story. We are interested in hearing about your experience as a patient at Resurrection. Go to our website at www.reformresurrection. org and find the link to tell us your patient story.

Endnotes:

i Pg 9 Institute of Medicine, National Academy of Sciences. “To Err is Human: Building a Safer Healthcare System.” 1999ii Aiken, Linda et.al. “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction.” Journal of the American Medical Association v 288. 16. 2003

iii Berens, M.J. “Infection Epidemic Carves Deadly Path. Poor Hygiene, Overwhelmed Workers Contribute to Thousands of Deaths.” The Chicago Tribune July 21, 2002

iv IRS Forms 990 2000-2005 for each Resurrection hospital and Audited Financial Statements, Resurrection Healthcare and Affiliates

v Centers for Medicare and Medicaid Services (CMS) forms HCFA-2567, HCFA-2567B, HCFA-1539 and HCFA-562 for inspections of Resurrection Health Care Hospitals 2003-2007

vi Letters from CMS to Resurrection Healthcare obtained from the Illinois Department of Health through a Freedom of Information Act request.

vii US Department of Health and Human Services' Hospital Compare Website. http://www.hospitalcompare.hhs.gov/ Accessed December 2006

viii Ibid.

ix Blue Cross and Blue Shield of Illinois. Blue Star Hospital Report 2006.

x Ibid.

xi Ibid.

xii Resurrection Health Care. Inside Resurrection. September 2003 and see www.hfap.org, HFAP Accredited Hospitals accessed January 2007.

xiii See www.jcaho.org. “Shared Visions New Pathways Q&A”, September 2003.

xiv Institute for Health and Socioeconomic Policy. “The Second Annual IHSP Hospital 200” (2004) and “The Third Annual IHSP Hospital 200” (2005).

xv Ibid.

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